{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"June E Heggeman","gend":1,"currentgend":"","add":"2 VILLAGE VIEW RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1949-12-07","age":"","mstatus":"","insh":"10000053067","cliId":"","pno":2076424068,"cno":"","email":"","ename":"","eno":"","pphy":"ROVNER, ROBERT B","ppno":2076753121,"pcpadd":"Steep Falls Family Practice,PO Box 39","pcpcity":"Steep Falls","pcpstate":"ME","pcpzip":"04085","pcpcounty":"","pcpid":"","pcpname":"STEEP FALLS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 VILLAGE VIEW RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2076753396,"pcpnpi":1902912371,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7GM0AJ4VY27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R911","D0339","I4891","L97522","M79672","E08610","R918","Z1231","S8992XA","M25469","E119","L97519","E11621","E118","L97529","D485","L97411","A000","S40021A","Z23","R079","T148XXA","M25559","C44311","L97422","R0789","E8342","I1310","E1122","D179","L570","L578","D229","L821","L814","I2510","I480","Z7901","Z955","E11610","R2689","J8489","R2681","I4819","I10","Z96652","S80212A","W01198A","Y92009","M216X9","F32A","M549","M6702","I739","E1149","Z471","Z01812","E1140","M19072","E1142","L851","B351","M25519","R069","D492","Z4789","D225","L304","M25562","Z0101","L738","Z85828","L97515","L97511","E785","L97512","E1121","E13621","M5459","L03116","M62461","R531","I7389","L97502","G629","I4821","I252","M79674","M79671","L84","M79675","H35341","H26493"],"date":["2024-05-13","2025-09-29","2025-10-14","2025-05-06","2024-06-04","2024-06-04","2025-11-04","2025-05-15","2024-12-08","2024-12-08","2024-12-23","2025-05-19","2025-10-25","2024-12-23","2025-05-19","2025-07-30","2025-09-26","2025-08-21","2025-10-14","2025-10-14","2024-04-16","2024-12-12","2025-06-30","2024-02-16","2025-07-29","2023-08-02","2023-08-02","2023-08-02","2023-08-02","2025-05-20","2024-12-02","2024-06-18","2023-12-19","2024-06-18","2023-12-19","2025-05-28","2023-10-09","2024-04-11","2023-10-09","2025-10-31","2025-09-19","2024-08-13","2025-10-31","2024-04-11","2025-04-18","2024-12-12","2024-12-08","2024-12-08","2024-12-08","2025-08-28","2025-08-28","2024-04-16","2024-10-31","2024-05-06","2024-05-06","2024-12-12","2024-10-21","2024-03-04","2024-09-24","2022-12-28","2022-12-28","2022-12-28","2024-04-16","2024-04-16","2023-10-05","2024-11-18","2024-06-18","2024-06-18","2024-12-26","2025-09-22","2024-06-18","2024-09-12","2025-05-06","2025-07-01","2025-04-18","2023-04-17","2022-12-20","2024-05-20","2023-08-01","2024-03-29","2025-08-28","2025-08-14","2024-01-26","2024-01-26","2025-10-31","2022-10-27","2022-10-27","2022-10-13","2022-09-22","2022-09-06","2022-09-06","2022-02-28","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","GLIPIZIDE XL","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}